Our values: clinical engagement, patient involvement, local ownership, national support

www.england.nhs.uk/vanguards #futureNHS

New care models

New Care Models: Learning from the

care homes vanguards

William Roberts

06 December 2016

Enhanced Health in Care Homes

2

Providing joined-up primary,

community and secondary,

social care to residents of

care/ nursing homes and Extra

care Living Schemes

But none of this is that new…

There are a range of excellent resources

already available and there is great work

going on all over the country

• Standard healthcare provision delivered to care homes does not meet residents needs but well-tailored services can make a significant difference

• Consensus re characteristics of high quality care – consistent access to expertise in geriatric medicine; investment in cross-organisational working; structured interventions which can be monitored – but still divergence of views as to the significance of each of these elements

• Importance of considering health in relation to wellbeing, mental health and “a better life”

• “Relational working” (care home staff + visiting healthcare professionals) is key success ingredient – incentives, protocols and boosting clinical input/expertise not enough on their own

• Good leadership, co-production with providers, residents, staff, families and carers vital

• Investment in targeted training for staff esp. in relation to dementia, management of LTCs and EOL – poor staff knowledge associated with increased ambulance calls & GP referrals

• Robust evidence re Comprehensive Geriatric Assessment and improved outcomes for residents

There's a significant evidence base

for this work

So we all know what to do, but how do

you do it and why now

Going back to the start

5

• England 3x as many beds in care homes as there are

in the NHS but reduction in numbers of nursing home

beds this year + increase in care home closures

• Social care faces significant financial pressures

• Care homes residents are a frail, vulnerable

population with increasingly complex needs &

dependency

• Hospital-based interventions have limited

effectiveness for this population

• Ageing population with 1 in 7 over 85 living in a care

home

Real challenges

What the vanguards are doing

differently is trying to do this is a

joined up way across a place and

population…

…we have intentionally built on what

already exists

Person-centred change

• Putting the needs of the resident or person with care needs at the centre of

any changes

• Supporting carers and families as well as those with care needs

Co-production

• Working and integrating with local government, the community and the

voluntary and care homes sectors to co-design and co-deliver the model of

care

• Acknowledging the value of the care home sector in supporting the NHS and

the significant level of healthcare that is delivered in care homes by social

care staff

• Adopting a whole-system approach, breaking down organisational barriers

between health, social care and the voluntary sector

Quality

• A focus on quality as the driving factor for change

• Using clinical evidence to support as well as drive change

Leadership

• Strong leadership and a joint shared vision for better care

• Recognising the cultural differences between organisations and different

types of commissioner and provider and focussing on the shared care aims

despite differences in language and process

What is the EHCH model about?

How are the vanguards improving care?

• Video to be inserted here

6 places is great…but imagine if we could go from 6 to the whole

country

How are we planning on achieving

this What do we want to spread?

• The EHCH care model and its key elements and interventions as defined in the

framework.

• If you're not ready to implement the full care model, adopt and adapt the frugal

innovations which individually do not make a significant impact but aggregated

make a series of marginal gains which can significantly improve quality,

sustainability and outcomes.

However…

• Spread of the EHCH care model isn’t about decommissioning existing services

where these work well and fit local circumstance.

• We want to build upon good practice that is already in place in many areas,

recognising differing levels of existing provision against each element of the

model.

• Other local factors such as clinical variations, mix of system providers, digital and

physical infrastructure, and the local employment market will also influence the

pace at which each area can implement the model.

• Framework published 29th

September

• Aims to describe the care model

and describe plan for spread

• Care model has 7 core elements

and 18 sub elements

• Intention to spread the care model

across England next year

Enhanced Health in Care Homes (EHCH) care model

Care element Sub-element

1. Enhanced primary care support Access to consistent, named GP and wider primary care service

Medicine reviews

Hydration and nutrition support

Access to out-of-hours/urgent care when needed

2. MDT in-reach support Expert advice and care for those with the most complex needs

Helping professionals, carers and individuals with needs navigate the health and care system

3. Re-ablement and rehabilitation to supportindependence

Reablement / rehabilitation services

Developing community assets to support resilience and independence

4. High quality end of life care and dementia care End-of-life care

Dementia care

5. Joined up commissioning and collaboration between health and social care

Co-production with providers and networked care homes

Shared contractual mechanisms to promote integration (including continuing healthcare)

Access to appropriate housing options

6. Workforce development Training and development for social care provider staff

Joint workforce planning across all sectors

7. Harnessing data and technology Linked health and social care data sets

Access to the care record and secure email

Better use of technology in care homes

Self-assessment tool • Since the launch of the

framework we have been

developing a simple self-

assessment tool

• Bring together your

partners to work through

the tool

• You will discover things you

didn’t know were out there

• We will look to offer support

to you to develop your work

• We will launch this in the

new year

• Person centred approach essential and focus on the populations

health

• Build collaborative system leadership and relationships around a

shared vision for the population

• Care homes critical partner in the work at all stages

• Able to see very quick benefits for residents, providers and wider

system

• Not one change that makes a difference, requires a coordinated

approach to improvement

• Opportunities to apply the care model wider than just care homes

What have we learned from the care home vanguards

• www.england.nhs.uk/vanguards

• #futurenhs

• https://www.england.nhs.uk/wp-

content/uploads/2016/09/ehch-

framework-v2.pdf

• #kfcarehomes

For more information